Link between diabetics who have AF and risk of heart problems and death


Results from a large, international, randomised, controlled trial have shown that there is a strong link between diabetics who have atrial fibrillation and an increased risk of other heart-related problems and death. The findings were published on 12 March, 2009 in The European Heart Journal.

The ADVANCE study of 11,140 patients with type 2 diabetes found that patients who had atrial fibrillation at the start of the trial had a 61% increased risk of dying from any cause, a 77% increased risk of dying from cardiovascular causes such as a heart attack or stroke, and a 68% increased risk of developing heart failure or other cerebrovascular problems such as stroke, when compared with diabetic patients who did not have atrial fibrillation.

However, the study also found that if clinicians gave more aggressive treatments to the diabetic atrial fibrillation patients – in this study they treated them with a combination blood pressure lowering drugs, (perindopril and indapamide) – the risk of dying or developing any of these complications was reduced. It was also reduced in diabetic patients without atrial fibrillation who were given the same treatment.

Professor Anushka Patel, The George Institute for International Health (University of Sydney, Australia), who led the study, said: “Active treatment produced similar relative benefits to patients with and without atrial fibrillation. However, because of their higher risk at the start of the study, the absolute benefit associated with active treatment was greater in patients with atrial fibrillation than without. We estimate that five years of active treatment would prevent one death among every 42 patients with atrial fibrillation and one death among every 120 patients without atrial fibrillation.”

Patel said: “The prevalence of atrial fibrillation varies greatly according to the population’s age and other health problems. It ranges between 4% in primary care settings to 15% in hospitalised patients. In our study, 847 (7.6%) of the 11,140 patients had atrial fibrillation at baseline and a further 352 patients developed atrial fibrillation over an average follow-up of 4.3 years. The overall prevalence in this population was about 11%. There are data to suggest that the prevalence of atrial fibrillation in people with diabetes is about twice that among people without diabetes.

“The number of diabetic patients is projected to increase to 380 million at 2025. We might expect that about 40 million of these will also have atrial fibrillation. Thus the study findings have direct implications for a large number of individuals globally,” said Patel.